Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 12, pp 3810–3817 | Cite as

Comparable clinical and structural outcomes after arthroscopic rotator cuff repair in diabetic and non-diabetic patients

  • Katsutoshi Miyatake
  • Yoshitsugu TakedaEmail author
  • Koji Fujii
  • Naoto Suzue
  • Yoshiteru Kawasaki
  • Yasuyuki Omichi
  • Kenji Yokoyama



To compare clinical outcome and rotator cuff integrity after arthroscopic rotator cuff repair (ARCR) in patients with and without diabetes mellitus.


This retrospective study involved 264 consecutive patients who underwent ARCR from 2012 to 2015. Inclusion criteria were a medium or large-sized tear and a minimum of 1-year follow-up. Clinical outcome measures included range of motion (ROM) and the Japanese Orthopaedic Association (JOA) and University of California, Los Angeles (UCLA) scores preoperatively and at final follow-up. Rotator cuff retear was evaluated with magnetic resonance imaging at 3 months post-surgery and final follow-up. Diabetic patients with poor control were pre-operatively hospitalized for intensive diabetic control.


Our inclusion criteria were met by 30 diabetic patients and 126 non-diabetic patients. Demographic data were not significantly different between the groups, except body mass index (p = 0.021). Preoperative JOA and UCLA scores of the diabetic patients were significantly lower than those of the non-diabetic patients (p < 0.001, and p = 0.006, respectively); however, the scores at final follow-up were not different. ROM was significantly restricted in the diabetic patients before surgery (forward flexion, abduction, internal rotation: p < 0.001, external rotation: p = 0.035), but at the final follow-up, there was no significant difference except for internal rotation (p = 0.005). The retear rate in diabetic patients (23.3%) was not significantly different from that in non-diabetic patients (15.1%).


Diabetic patients who had good perioperative glycemic control showed clinical and structural outcomes comparable to non-diabetic patients after ARCR. Intensive perioperative glycemic control and patient education are recommended for preoperative uncontrolled diabetic patients.

Level of evidence



Rotator cuff tear Arthroscopic rotator cuff repair, retear Diabetes mellitus In-hospital diabetes education 



The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethical committee of Tokushima Red Cross Hospital (Tokubyoso-283).


  1. 1.
    Abate M, Schiavone C, Salini V, Andia I (2013) Management of limited joint mobility in diabetic patients. Diabetes Metab Syndr Obes 6:197–207CrossRefGoogle Scholar
  2. 2.
    Ahmed AS (2016) Does diabetes mellitus affect tendon healing? Adv Exp Med Biol 920:179–184CrossRefGoogle Scholar
  3. 3.
    Bedi A, Fox AJ, Harris PE, Deng XH, Ying L, Warren RF et al (2010) Diabetes mellitus impairs tendon-bone healing after rotator cuff repair. J Shoulder Elbow Surg 19:978–988CrossRefGoogle Scholar
  4. 4.
    Blonna D, Fissore F, Bellato E, La Malfa M, Calo M, Bonasia DE et al (2017) Subclinical hypothyroidism and diabetes as risk factors for postoperative stiff shoulder. Knee Surg Sports Traumatol Arthrosc 25:2208–2216CrossRefGoogle Scholar
  5. 5.
    Chan JH, Ho BS, Alvi HM, Saltzman MD, Marra G (2017) The relationship between the incidence of adhesive capsulitis and hemoglobin A1c. J Shoulder Elbow Surg 26:1834–1837CrossRefGoogle Scholar
  6. 6.
    Chen AL, Shapiro JA, Ahn AK, Zuckerman JD, Cuomo F (2003) Rotator cuff repair in patients with type I diabetes mellitus. J Shoulder Elbow Surg 12:416–421CrossRefGoogle Scholar
  7. 7.
    Cho CH, Kim DH, Lee YK (2016) Serial comparison of clinical outcomes after arthroscopic capsular release for refractory frozen shoulder with and without diabetes. Arthroscopy 32:1515–1520CrossRefGoogle Scholar
  8. 8.
    Cho NS, Moon SC, Jeon JW, Rhee YG (2015) The influence of diabetes mellitus on clinical and structural outcomes after arthroscopic rotator cuff repair. Am J Sports Med 43:991–997CrossRefGoogle Scholar
  9. 9.
    Chung SW, Huong CB, Kim SH, Oh JH (2013) Shoulder stiffness after rotator cuff repair: risk factors and influence on outcome. Arthroscopy 29:290–300CrossRefGoogle Scholar
  10. 10.
    Clement ND, Hallett A, MacDonald D, Howie C, McBirnie J (2010) Does diabetes affect outcome after arthroscopic repair of the rotator cuff? J Bone Joint Surg Br 92:1112–1117CrossRefGoogle Scholar
  11. 11.
    DeOrio JK, Cofield RH (1984) Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am 66:563–567CrossRefGoogle Scholar
  12. 12.
    Dhar Y, Anakwenze OA, Steele B, Lozano S, Abboud JA (2013) Arthroscopic rotator cuff repair: impact of diabetes mellitus on patient outcomes. Phys Sportsmed 41:22–29CrossRefGoogle Scholar
  13. 13.
    Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8:599–605CrossRefGoogle Scholar
  14. 14.
    Gasbarro G, Ye J, Newsome H, Jiang K, Wright V, Vyas D et al (2016) Morphologic risk factors in predicting symptomatic structural failure of arthroscopic rotator cuff repairs: tear size, location, and atrophy matter. Arthroscopy 32:1947–1952CrossRefGoogle Scholar
  15. 15.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83Google Scholar
  16. 16.
    Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg 12:550–554CrossRefGoogle Scholar
  17. 17.
    Healy SJ, Black D, Harris C, Lorenz A, Dungan KM (2013) Inpatient diabetes education Is associated with less frequent hospital readmission among patients with poor glycemic control. Diabetes Care 36:2960–2967CrossRefGoogle Scholar
  18. 18.
    Hsu CL, Sheu WH (2016) Diabetes and shoulder disorders. J Diabetes Investig 7:649–651CrossRefGoogle Scholar
  19. 19.
    Huang SW, Wang WT, Chou LC, Liou TH, Chen YW, Lin HW (2016) Diabetes mellitus increases the risk of rotator cuff tear repair surgery: a population-based cohort study. J Diabetes Complications 30:1473–1477CrossRefGoogle Scholar
  20. 20.
    Ide J, Maeda S, Takagi K (2005) A comparison of arthroscopic and open rotator cuff repair. Arthroscopy 21:1090–1098CrossRefGoogle Scholar
  21. 21.
    Jeong HY, Kim HJ, Jeon YS, Rhee YG (2018) Factors predictive of healing in large rotator cuff tears: is it possible to predict retear preoperatively? Am J Sports Med. CrossRefPubMedGoogle Scholar
  22. 22.
    Kim IB, Kim MW (2016) Risk factors for retear after arthroscopic repair of full-thickness rotator cuff tears using the suture bridge technique: Classification system. Arthroscopy 32:2191–2200CrossRefGoogle Scholar
  23. 23.
    Lin TT, Lin CH, Chang CL, Chi CH, Chang ST, Sheu WH (2015) The effect of diabetes, hyperlipidemia, and statins on the development of rotator cuff disease: a nationwide, 11-year, longitudinal, population-based follow-up study. Am J Sports Med 43:2126–2132CrossRefGoogle Scholar
  24. 24.
    Mehta SS, Singh HP, Pandey R (2014) Comparative outcome of arthroscopic release for frozen shoulder in patients with and without diabetes. Bone Joint J 96-B:1355–1358CrossRefGoogle Scholar
  25. 25.
    Nakamura H, Gotoh M, Mitsui Y, Honda H, Ohzono H, Shimokobe H et al (2016) Factors Affecting Clinical Outcome in Patients With Structural Failure After Arthroscopic Rotator Cuff Repair. Arthroscopy 32:732–739CrossRefGoogle Scholar
  26. 26.
    Namdari S, Green A (2010) Range of motion limitation after rotator cuff repair. J Shoulder Elbow Surg 19:290–296CrossRefGoogle Scholar
  27. 27.
    Puah KL, Salieh MS, Yeo W, Tan AHC (2018) Outcomes of arthroscopic capsular release for the diabetic frozen shoulder in Asian patients. J Orthop Surg (Hong Kong) 26:1–4CrossRefGoogle Scholar
  28. 28.
    Sonoda R, Tanaka K, Kikuchi T, Onishi Y, Takao T, Tahara T et al (2016) C-peptide level in fasting plasma and pooled urine predicts hba1c after hospitalization in patients with type 2 diabetes mellitus. PLoS One 11:e0147303CrossRefGoogle Scholar
  29. 29.
    Sugaya H, Maeda K, Matsuki K, Moriishi J (2007) Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study. J Bone Joint Surg Am 89:953–960CrossRefGoogle Scholar
  30. 30.
    Thomas SJ, McDougall C, Brown ID, Jaberoo MC, Stearns A, Ashraf R et al (2007) Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus. J Shoulder Elbow Surg 16:748–751CrossRefGoogle Scholar
  31. 31.
    Torimoto K, Okada Y, Sugino S, Tanaka Y (2017) Determinants of hemoglobin A1c level in patients with type 2 diabetes after in-hospital diabetes education: a study based on continuous glucose monitoring. J Diabetes Investig 8:314–320CrossRefGoogle Scholar
  32. 32.
    Wang K, Ho V, Hunter-Smith DJ, Beh PS, Smith KM, Weber AB (2013) Risk factors in idiopathic adhesive capsulitis: a case control study. J Shoulder Elbow Surg 22:e24-29CrossRefGoogle Scholar
  33. 33.
    Yoo JC, Ahn JH, Yang JH, Koh KH, Choi SH, Yoon YC (2009) Correlation of arthroscopic repairability of large to massive rotator cuff tears with preoperative magnetic resonance imaging scans. Arthroscopy 25:573–582CrossRefGoogle Scholar
  34. 34.
    Zreik NH, Malik RA, Charalambous CP (2016) Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J 6:26–34PubMedPubMedCentralGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryYoshinogawa Medical CenterYoshinogawaJapan
  2. 2.Department of Orthopaedic SurgeryTokushima Red Cross HospitalKomatsushimaJapan

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